Best & worst exercises for bad knees

What does it mean to have bad knees? People with “bad knees” have pain; they can’t run or even stretch without feeling pain, and they often need support to feel stable, especially during physical activities.

Anatomy of Injury

The knee joints, which bear body weight all day long, are susceptible to injury when there’s poor biomechanical alignment (from the ankle up); and they are commonly traumatized during sports. Over time, with chronic injury or repetitive trauma, arthritis may occur.

Structures at risk for damage in the knee include the ligaments inside the joint, the ligaments and tendons crossing the joint on the outside, and the meniscus–a cartilage ring or disc which helps cushion the joint and hold the bones in alignment. Direct impact causing shearing forces on the knee during soccer, rugby and football result in tears of these ligaments. Impact can also result in patellar bone dislocation and/or fracture.

Hyperpronation and hypersupination at the ankle joint translate to uneven distribution of weight across the tibial plateau at the knee during weight bearing. Over time, the meniscus, bone cartilage, and then the bone, wear down on the side that bears weight incorrectly. This causes pain and a sense of instability. Biomechanical problems at the knee itself (such as hyperextension and tibial bone deformities) and mal-alignment in the hips and back also can cause knee pain. Mal-alignments may be caused by tight muscles.

According to the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, and the National Center for Health Statistics, women tend to sustain knee injuries more often than men, and the knees of adolescents seem to be the most at risk because this group is most active.

Rehab after Treatment

Once your injury has been treated, either surgically or palliatively, by a physician, and you have been approved for return back to normal activities, the following exercises are recommended by the American Academy of Orthopaedic Surgeons for recovering knee joints.

Knee exercises typically recruit the muscles of the quadriceps and hamstring complexes, which are responsible for flexing and extending this joint. Determining the best knee exercise depends on your tolerance. Most of these exercises can be performed either lying down on the Total Gym or standing. As you gain strength, you can use resistance in the form of dumbbells, barbells, cables or ankle weights.

1. Half Squats: Keep feet parallel, toes pointed straight ahead. Align the knees over the ankles. Strengthens the quads, glutes and hamstrings.
2. Straight Leg Extensions: Lying down or in a seated position, raise one leg, keeping the knee straight. Strengthens the quads.
3. Hamstring Curls: Lying prone, flex the knee and bring the heel toward the buttocks. Strengthens the hamstrings.
4. Abduction: Lie on your side and lift the top leg. Bottom leg can be bent or straight. Strengthens the muscles of the outer thigh and buttocks.
5. Adduction: Lie on your side and lift the bottom leg. The top leg is bent or straight. Strengthens the muscles of the inner thigh.
6. Rear Leg Lift: Lying prone on the floor or on a bench, lift one leg at a time with a straight knee. Builds the glutes.
7. Heel Raises: Standing on a platform on the balls of the feet with your knees straight, raise your heels. Strengthens the gastrocnemius-soleus muscles.
8. Advanced: Seated Flexed Hip Leg Extension: Sitting in a chair, lift both feet off the floor. Try to get your knees as close to your chest as possible. Extend your legs, then flex the knees and return your feet to the floor. Strengthens the core musculature along with the quads.

For cardiovascular options that are easy on the knees, choose low-impact or no-impact exercises such as swimming, elliptical machine, recumbent cycling, step-ups or stair-climbing. If you experience feelings of instability, you may require a knee brace. Stop all activity if there is new onset of pain and swelling.

Stretch for Better Function

Stretching after a warm-up and after working out is highly beneficial. If you notice that one side of your body is more flexible than the other, that’s normal, but work on increasing the range of motion on the tight side.

1. Hamstring stretch: Supine straight leg hold
2. Quadriceps: Side-lying foot hold with bent knee
3. Gastroc-soleus complex: Downward dog with heels pressed down
4. Hips: Supine or seated figure 4

Bad Knees? Avoid These

1. Jogging/Running
2. Jumping Rope
3. Walking/Deep Lunges
4. Full-Arc Knee Extension
5. Deep Squats

Tips for Good Form

1. Do not hyperflex the knees by squatting so that the buttocks sit below the hips. You will see Olympic lifters do this, but it is very hard on the knee joints.
2. Do not allow the knees to go past the toes in lunges or squats. Keep the knees aligned over the ankles.
3. Do not hyperextend the knees by landing with straight legs during plyometrics or by pedaling on a bike with the seat too high.
4. Be careful when using a leg press machine: do not lock out the knees and avoid pushing excessive weight, especially if you’ve already injured your knees.
5. Avoid repetitive motion day in and day out at high intensity, such as biking uphill, running long distances up and down hill, jumping up and down on a high platform.